Treatment of Colorectal Hepatic Metastases by Intrahepatic Chemotherapy Alone or as an Adjuvant to Complete or Partial Removal of Metastatic Disease

Abstract

Because of the wide variation in reported benefits from the use of intrahepatic chemotherapy for colorectal hepatic metastases, the authors performed their own phase II studies comparing the use of intrahepatic chemotherapy alone and intrahepatic chemotherapy as an adjuvant to complete or partial removal of metastatic colorectal cancer to the liver. Techniques for partial removal included unilateral and bilateral wedge resection, peripheral presinusoidal embolization of the liver, and portal vein branch ligation. Patients were staged using the per cent hepatic replacement method of Pettavel and Taylor, and patients with bilateral metastases were included in the study. Twenty-seven patients, mean age 60.3 years, were examined. There were 19 males, mean age 60.4 years, and eight females, mean age 60 years. The patients were divided into four groups. Group A had an implantable pump only; Group B had an implantable pump and resection; Group C had an implantable pump and arterial embolization and portal vein branch ligation; and Group D had an implantable pump, partial resection, arterial embolization, and portal vein branch ligation. Kaplan-Meyer survival curves were calculated for all of these groups. A separate analysis was carried out for each of the stages, and a comparison was made. The study indicated that the overall median survival time was 18 months and that the more radical the treatment in addition to chemotherapy, the better the results. Such results were not totally dependent on the staging of the tumor volume but were dependent on the degree of extirpation of the tumor. In Group C, consisting primarily of Stage IIa, IIIa, and IV patients (i.e., unresectable patients), a doubling of expected median survival to 12 months could be achieved, compared to those in Group A, which achieved a median survival of only 6 months.

Regional chemotherapy of non-resectable liver metastases from colorectal cancer - literature and institutional review

“…Therefore, regional chemotherapy has been advocated as a better treatment option, since high drug concentrations at low or no systemic drug levels were possible, depending on the drug used. However, systemic drug levels should be present to effect the portally perfused Hodgson [30] 1986 5-FUDR i.a. + others 6 -med.…”

“…When 5-FUDR is used for neoadjuvant therapy, surgical morbidity and mortality may be exceedingly high [30,61] and a group using 5-FUDR-based protocols for regional chemotherapy of CRLM explored only 3 of 300 patients (1%) for secondary resection [71].…”

Active specific immunotherapy with Newcastle-diseasevirus-modified autologous tumor cells following resection of liver metastases in colorectal cancer

“…Recurrent disease is related to micrometastases not detectable at the time of surgery. Unfortunately postoperative chemotherapy did not improve the prognosis in this group of patients [5,11]. Therefore, on the basis of experimental and the first clinical data, we selected this group of patients for active immunotherapy.…”

“…The most frequent site of recurrence is the liver, most often because of micrometastases not detectable at the time of liver resection [9]. Attempts to improve results in this group of patients by adjuvant chemotherapy following surgery were of limited success [5,11]. An alternative approach to be tested in this situation is immunotherapy.…”

Welche berechtigung hat die arterielle chemotherapie in der behandlung von kolorektalen lebermetastasen?

“…Nach Leberresektion treten in bis zu 80% Rezidive erneut in der zuvor operierten Leber auf, davon k6nnen 20 bis 40% der Herde isoliert auftreten [23,26]. In den bisher publizierten Studien war die regionale Therapie nicht mit einer zus~itzlichen Morbidit~it oder Letalit~it assoziiert [9,11,23,25,27,28,34]. Die intrahepatische Rezidivrate konnte, soweit aus den Pilotstudien interpretierbar, insbesondere bei einer Solit~irmetastase, deutlich reduziert werden.…”